0001209191-14-012993.txt : 20140221 0001209191-14-012993.hdr.sgml : 20140221 20140221151800 ACCESSION NUMBER: 0001209191-14-012993 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140219 FILED AS OF DATE: 20140221 DATE AS OF CHANGE: 20140221 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CONCERT PHARMACEUTICALS, INC. CENTRAL INDEX KEY: 0001367920 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 99 HAYDEN AVENUE STREET 2: SUITE 500 CITY: LEXINGTON STATE: MA ZIP: 02421 BUSINESS PHONE: 781-860-0045 MAIL ADDRESS: STREET 1: 99 HAYDEN AVENUE STREET 2: SUITE 500 CITY: LEXINGTON STATE: MA ZIP: 02421 FORMER COMPANY: FORMER CONFORMED NAME: CONCERT PHARMACEUTICALS INC DATE OF NAME CHANGE: 20060628 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WAN MARK A CENTRAL INDEX KEY: 0001190472 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14633263 MAIL ADDRESS: STREET 1: C/O THREE ARCH PARTNERS STREET 2: 3200 ALPINE RD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: THREE ARCH PARTNERS III LP CENTRAL INDEX KEY: 0001256741 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14633264 BUSINESS ADDRESS: STREET 1: C/O THREE ARCH PARTNERS STREET 2: 3200 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 BUSINESS PHONE: 6505298000 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: THREE ARCH ASSOCIATES III LP CENTRAL INDEX KEY: 0001113520 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14633265 BUSINESS ADDRESS: STREET 1: C/O THREE ARCH PARTNERS STREET 2: 3200 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 BUSINESS PHONE: 6505298000 MAIL ADDRESS: STREET 1: C/O THREE ARCH PARTNERS STREET 2: 3200 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JAEGER WILFRED E CENTRAL INDEX KEY: 0001190474 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14633266 MAIL ADDRESS: STREET 1: C/O THREE ARCH PARTNERS STREET 2: 3200 ALPINE RD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: THREE ARCH MANAGEMENT III LLC CENTRAL INDEX KEY: 0001256738 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14633267 BUSINESS ADDRESS: STREET 1: C/O THREE ARCH PARTNERS STREET 2: 3200 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 BUSINESS PHONE: 6505298000 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-02-19 1 0001367920 CONCERT PHARMACEUTICALS, INC. CNCE 0001256738 THREE ARCH MANAGEMENT III LLC 3200 ALPINE ROAD PORTOLA VALLEY CA 94028 1 0 1 0 0001190474 JAEGER WILFRED E C/O THREE ARCH PARTNERS 3200 ALPINE ROAD PORTOLA VALLEY CA 94028 1 0 1 0 0001113520 THREE ARCH ASSOCIATES III LP 3200 ALPINE ROAD PORTOLA VALLEY CA 94028 0 0 1 0 0001256741 THREE ARCH PARTNERS III LP 3200 ALPINE ROAD PORTOLA VALLEY CA 94028 0 0 1 0 0001190472 WAN MARK A C/O THREE ARCH PARTNERS 3200 ALPINE ROAD PORTOLA VALLEY CA 94028 0 0 1 0 Common Stock 2014-02-19 4 C 0 13545 A 14854 I See footnote Common Stock 2014-02-19 4 C 0 18060 A 32914 I See footnote Common Stock 2014-02-19 4 C 0 3612 A 36526 I See footnote Common Stock 2014-02-19 4 C 0 251941 A 276295 I See footnote Common Stock 2014-02-19 4 C 0 335922 A 612217 I See footnote Common Stock 2014-02-19 4 C 0 67184 A 679401 I See footnote Common Stock 2014-02-19 4 P 0 5281 14.00 A 41807 I See footnote Common Stock 2014-02-19 4 P 0 98219 14.00 A 777620 I See footnote Series A Convertible Preferred Stock 2014-02-19 4 C 0 76531 0.00 D Common Stock 13545 0 I See footnote Series B Convertible Preferred Stock 2014-02-19 4 C 0 102041 0.00 D Common Stock 18060 0 I See footnote Series C Convertible Preferred Stock 2014-02-19 4 C 0 20408 0.00 D Common Stock 3612 0 I See footnote Series A Convertible Preferred Stock 2014-02-19 4 C 0 1423469 0.00 D Common Stock 251941 0 I See footnote Series B Convertible Preferred Stock 2014-02-19 4 C 0 1897959 0.00 D Common Stock 335922 0 I See footnote Series C Convertible Preferred Stock 2014-02-19 4 C 0 379592 0.00 D Common Stock 67184 0 I See footnote The Series A, Series B and Series C Convertible Preferred Stock converted into Common Stock on a 1-for-5.65 basis upon the closing of the issuer's initial public offering without payment of consideration. These shares are owned directly by Three Arch Associates III, L.P. ("TAA III"). Three Arch Management III, L.L.C. ("TAM III") is the general partner of TAA III, and Wilfred Jaeger and Mark Wan, the Managing Members of TAM III, may be deemed to share voting and dispositive power over the shares held by TAA III. Such persons and entities disclaim beneficial ownership of the shares held by TAA III except to the extent of any pecuniary interest therein. These shares are owned directly by Three Arch Partners III, L.P. ("TAP III"). Three Arch Management III, L.L.C. ("TAM III") is the general partner of TAP III, and Wilfred Jaeger and Mark Wan, the Managing Members of TAM III, may be deemed to share voting and dispositive power over the shares held by TAP III. Such persons and entities disclaim beneficial ownership of the shares held by TAP III except to the extent of any pecuniary interest therein. Not applicable. /s/ Wilfred Jaeger, as Managing Member of Three Arch Management III, L.L.C. 2014-02-21 /s/ Wilfred Jaeger 2014-02-21 /s/ Wilfred Jaeger, as Managing Member of Three Arch Management III, L.L.C., general partner of Three Arch Associates III, L.P. 2014-02-21 /s/ Wilfred Jaeger, as Managing Member of Three Arch Management III, L.L.C., general partner of Three Arch Partners III, L.P. 2014-02-21 /s/ Mark Wan 2014-02-21